Vestibular neuritis is also known as vestibular neuronitis and is an inflammation of a person’s vestibulocochlear nerve, specifically the vestibular portion of it. This nerve is responsible for sending messages between the vestibular organs within the inner ear and the brain. These vestibular organs are three semicircular canals that are loop-shaped as well as two structures which are sac-shaped, the saccule and utricle. Within these organs, there are hair and fluid cells that give information to the brain concerning the head’s movement and position. It is this information that helps us maintain balance, thanks to the combination of messages from each ear. In the case of vestibular neuritis, the messages sent to each ear will be different, leading to vertigo or dizziness. Although this condition is rare in children, it can affect people of any age.
Symptoms of vestibular neuritis include:
Some patients may also have rapid eye movements that are in the same direction as the unaffected ear. When this symptom occurs without other neurological symptoms, many doctors will see it as a clue that vestibular neuritis may be to blame.
In the majority of cases, the worst of these symptoms will be the severe dizziness and vertigo, which will only last several days, during which time it is very challenging to perform daily activities. Once the severe symptoms begin to improve, the majority of patients will slowly make a full recovery over the course of around three weeks. In some cases, however, balance and dizziness issues may persist several months. There is typically no permanent damage as a result of vestibular neuritis and patients will usually make a full recovery, being able to continue with their daily lives as normal.
The fact is, vestibular neuronitis is typically due to a viral infection of some sort. This can be an infection of only your inner ear, or one that affects the entire body, the second of which is known as a systemic viral infection. Some examples of infections which have been linked to this condition include hepatitis, mumps, influenza, mononucleosis, measles, and the herpes virus. In some cases, vestibular neuritis can result from bacterial middle ear infections spreading to a person’s inner ear, but this is rare, with the above systemic viral infections being more likely to cause the condition.
Vestibular neuritis treatment involves managing the symptoms and treating the virus which caused it (when applicable). There are also frequently balance rehabilitation programs.
The main focus of initial treatment for vestibular neuritis is to manage the symptoms. There are drugs that can reduce the associated nausea, including metoclopramide (Reglan) and ondansetron (Zofran). In cases of severe vomiting and nausea which can’t be controlled via drugs, a patient may need to enter the hospital for IV fluids to prevent and treat dehydration.
Drugs prescribed to treat dizziness include lorazepam (Ativan), compazine, diazepam (valium), and meclizine (Antivert). These drugs which reduce dizziness are classified as a group as vestibular suppressants and they should not be used for more than three days a time. Doctors don’t recommend these drugs for use over the long-term as they can make recovery challenging. In some cases, steroids will also be prescribed.
The medication and vestibular neuritis treatment will vary based on the virus which was diagnosed. In cases when herpes is the probable cause, the doctors will prescribe acyclovir or other antiviral medicines. Antibiotics will never be used as vestibular neuritis is due to viruses, not bacteria.
In cases when the dizziness and balance issue persist more than several weeks, vestibular physical therapy may become necessary. This therapy program retrains the brain, so it can adapt to balance changes experienced.
To begin the program, the therapist will evaluate all areas of the body affecting balance, including how well your legs sense balance, how vision helps to interpret your body’s position relative to surroundings, how the inner ear works to keep balance, and how the entire body finds a center of gravity, including possible unsteady postures or swaying.
For balance rehabilitation to be a success, the therapist will have the patient repeat their personalized exercise two or three times each day. As the patient repeats the exercises, the brain will begin to adjust to movements which are responsible for imbalance and dizziness. As a large number of the exercises will work well at home, the patient can speed up recovery. Before repeating exercises at home, the patient will receive specific instructions from their vestibular rehabilitation specialist concerning how to do each exercise. They will also provide additional safety tips to help prevent the patient from falling due to a lack of balance or from vertigo.
The results of the initial assessment of a patient’s balance will determine the exact exercises used during the balance rehabilitation program. Overall body posture balance exercises work to shift the body weight while standing, both doing so side-to-side and forward or backward.
Eye and ear head-turn exercises include having the patient focus their eyes on a particular object while turning their head side to side. They may also have to keep their vision steady while rapidly turning their head from the side to center or focus their eyes onto a distant object and briefly glance at the floor as they walk towards this object.
In the majority of cases, vestibular neuritis will only affect an individual a single time. This is true for at least 95 percent of patients who experience this condition. Additionally, most patients will make a full recovery, allowing them to continue their normal lives without worrying about vertigo or recurrences of other symptoms associated with vestibular neuritis.